20041049.pdfI
9
DATE RECEIVED LPERMITEXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMENAME OF BUSINESS qiIh
&f,(Aorr�,rih._m HOA PLAT NAM EIS UBDIVI SION NO. LOT NO. LID NO,
MAILING ADDRESS 2__ LIDFEE $
TESCP Approved 13
PUBLIC RIGI IT OF WAY PER OFFICIAL STREET MAP RW Permit Rnquired Q
A Len�,� tP\lJof -i Street Lisa Permit 1100 El
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CITY ZIP TELEPHONE EXISTING - PROPOSED InsprictionRequiled
Sidewalk Required [3
9 020 REQUIRED DEDICATION- F] underground
E18 9502.0 20 - 62 1�_ — wiring required [3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
TR YESIJ NO IJ
-nep-rL ry)
ADDRESS REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
1-4 LeaA 6LI;iin Age_une, 2.o i
CITY ZIP TELEPHONE
50t-,re� 3 C V`3� (oN -5-4 Ll -to LA 3 2
NAME CBL 0
I rl AVAIM ffir I
I I f"; j Ct 1 ENGINEERING REVIEWED BY DATE
CITY TELEPHONE
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h 11 ZIP
I STATE LIC�ilSg NUMBER EXPIRATION DATE
� r#-,C�k lo, 1- jo., - -_ ---vjr) I f.
PROPERTY TAX ACCOUNT PARCEL NO.
too -2 00
1:1 NEW 1:1 RESIDENTIAL
0 ADDITION 2] COMMERCIAL
1:1 REMODEL 1:1 MULTIFAMILY
11 REPAIR GRADING CYDS
E] DEMOLISH 11 TANK
oGARAGE RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
w NUMBER NUMBER OF
'3 OF DWELLING
to
0 STORIES 3 UNITS
DESCRIBE WORK TO BE DONE
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SOURCE GLAZING %
I I N M
PLAN CHECK NO:
PLUM13ING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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( _15 x H Fn
OTHER
FIRE SPRINKLER
FIREALARM
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CRITICAL
AREAS
NUMBER /� J
LOT SLOPE %
IV/14
VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
M PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
u) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
U)
III IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECI LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF'THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN I OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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FIRE REVIEWED BY DATE W
VARIANCE OR CU HORELINE OR ADB# INSPECTION BOND
RE POSTED
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SEPA REVIEW SIGN AREA HEIGHT
COMPXTE EXEMPT ALLOWED PROPOSED ALLOWI�D PROPOSED
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Exp 513,61 1 5*
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FROI�T SIDE- REAR FRONT LJR SIDE REAR. 0
a.0 15 15 rj,-4- 174— z
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PARKING LOT AREA I PrNING R WIEWD Y DATE
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REO'D I PROVIDED 0
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REMARKS _4,- NA_(PALv0 CtILL14 ,v eKled �e�,rkr c4`
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CHECKED 13� TYPE F CONSTRUCTION CQPE OCCUPALLT
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] Y1 LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-D 5
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VALUATION
$ --l-<7,
Description
FEE
Description
FEE
Plan Check
State Surcharge
IG6
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
712,
Recording Fee
Receipt #
7��
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a pennit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/tier Deputy* and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
JTION
T 0 F
RUC
YE
_ D
To
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
I - OFFICIALS SIGNATURE DATE
SIGNATURE (OWNER OR �dENT)/ DATE SIGNED (425)
1 61 6A 2., 771-0220 �El_ D'hy f DAYE
/I , 't 4
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW - INSPI?CT(�
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECEIVED
APR 14 2004
PERMIT COUNTER
PLr.ET DRIVE
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NOTES
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Amic 1 3 2004
M07 NORTH CAFEt PARKWAYN
SL41E 101
BOTHELL.WA Mll
PHONE (4251 3754=
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10 - fI600 - &ON A�
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1414 ITW AVENUE N
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ME155,2A)
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SITE PLAN
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Mar 02 04 09:03a T-Mobile USA 425-.:.,98-7470 p.G
03/02/2004 TUE 06:20 FAX 2064903839 ODELIA
MAR-01-04 MON i:Z:12 PM THOMI`t3�014 PRINTI14G
OWNER AUTHORIZATION AGREEMENT
Market: sazttle
Site Number: �Sgo 155
Z005/007
site Nanle: ob2mic yArw
Site Addrttss- I414V"Ave.NTPnj1fftM :103
Re: Froparty described as 1414 VhAve.N, FJironds, jVAqA02jQ (the "irg-opcity") and
is the owner orthe Property (the "O-wnee')
and has the: authority to enter into a leme norcamcint with VoiceStrearn PCS, III Corporation ("Voi=Stream")
canceming the portion of the Property that VoicaStream setks to ocrupy.
Owner hereby griults VolvoStrcarn and its agents a revocable right to cnter the Property to perform aoy
rcasonable tests ftt VoiceStream deems desirable, to determine the, feasibility of constructing and operating its
communications facility upon the Property, including but not limited to )) mdio frc4tiencY testing-, 2) 50its
testing; 3) on -site feasibility assesssmonts, and 4) fiJiDg of zoning applications (tho "Accoss Righel,
owner may revoke the Access Rigbtat any tiryie by dclivoring written notiw to VoiceStream by certified mail.
return receipt requested, aLthe following address:
VoiceStrearn PCS III CorporaUon
Attn-. Leasing Administrator
12920 SE 39'6 St
Bellevue, WA 98006
This notice will be cffmtive t1tree (3) days after actual receipt by VoiceStrearn, provided, however, that
VoiceStream may still enter the Property to ramove any equipment it has placed thLre.
VoiucSircaju agrees to repair any damage to the.Property caused by VoiceStrcaril's use of the Access Right.
Voic,eStrearn further agrees to indonuify, dc,1�4d and hold Owner Tharmless from and against any and all
&jmagcs, josscs and. expenses exising out of oe iesulting froin any c)aij)%, action or otlier proceeding tbal is based
upon ony negligent act or omission or willful' Ujisconduct of Voic-*Sveam or its ernployces or agcnts, arising in
C..onjoet:tion, witili tha Access Right.
EACH PARTY ACKNOWLEDGES THAT THE oTMR HAS MADE NO RE -PRESENTATIONS OR
COA%VVUTMENTS THAT A LEASE AGREEMENT CONCERNrNG THE PROPERTY WILL BE FNTERED
rNTO IN THE FUTURE.
VOICESTREAM PCS 111 CORPORATION'- OVII-MR;
By: '4�15 2 �
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By. zzk,
Name: Frite ghcids Nwlie;
Its:
Its- Ape 1,
Date- 200,1- Dale: 200_;K
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
FROM:
FM-E DEPARTMENT DATE
PLEASH SIGN z
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ENGINEERING DIVISION DATE I
PLEASESIGN 0
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PLANNING DIVISION DATE
I,LrASESIGN
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PROJECT V&L(:. -2 2(il
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SITE ADDRESS/ L4 ?cy Al 0 C:
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PERMIT
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DESCRIPTION OF WORK TO BE INSPECTED__CIC� T-6 Cn
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-approved plans. Final approval nx
A field inspection was conducted to determine compliance with >
denotes that there are no objections from tile above signed Department to the release of
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PERFORMANCE BONDS and the granting of: 0 U5
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X'_-GRANT FINAL PROJECT APPROVAL Z
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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0 Copy of CONDITIONS given to owner/contractor by inspector z
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
r-1 Copy of CORRECTION NOTICE given to owner/contractor by inpcctor
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3.
RE -INSPECTED OUTSTANDING ISS . UES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:bIdg:ronns:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
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Pier/Porch ................. 0
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING: --I
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Underground ............. C
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Rough -In ................... 0
0 C:
Commercial Final ...... rn
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HEATING: ID
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Gas Test ....................
Gas Piping ................. Cn
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Equipment.................
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-Commercial Final ....... IT!
EXTERIOR SHEATHING 0
0 M
NAILING .......................... C: Cn
9 Cn
FRAMING ........................ ITI 0
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FIRST FLOOR FRAMING ...
INSULATION ...................
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Floor Insulation ......... z
Wall Insulation ...........
Cn
Ceiling Insulation ....... z
0
SHEETROCK NAILING
0
171
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. Y22 z
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